Fertility clinics face tough call

Crowded labs feel pressure to discard unwanted embryos

September 12, 2004|By Judith Graham, Tribune staff reporter.

Nearly 500 embryos lie frozen in Thomas Pool's Texas fertility lab, abandoned by the men and women who created them.

For years, the scientist and his staff hoped in vain that the couples would come back to claim their potential progeny. Now, Pool said, he is considering doing what was previously unimaginable: removing the embryos from the cold and discarding them with his clinic's hazardous waste.

"We're to the point where we're out of room," said the embryologist, whose 1,000-square-foot lab in San Antonio is full to overflowing. "By all appearances, these embryos are unwanted. ... Something's got to give."

As the number of in-vitro fertilization procedures soars across the country, fertility clinics are feeling pressure to review the status of abandoned embryos--those whose parents have dropped out of touch and stopped paying fees for yearly storage. For the first time, a handful of clinics are suggesting they may dispose of these embryos.

Doctors and embryologists say it is one of the most difficult judgment calls they have to make. To many people, the embryos are alive--or at least potential life--and shouldn't be destroyed under any circumstances. To others, such as Pool, "these are not babies, they are not children. They're not even life forms that would survive without artificial intervention."

Although there is a growing movement to put frozen embryos up for adoption, that isn't possible for abandoned embryos because there is no one to sign away parental rights, lawyers said. Nor can clinics donate unwanted embryos to stem cell research, for the same reason.

Faced with the lack of clear guidelines, many centers--including those at Northwestern Memorial Hospital and Fertility Centers of Illinois--are preserving embryos indefinitely. But Pool's clinic in San Antonio and one at Rush University Medical Center in Chicago are among several now suggesting that they may discard abandoned embryos because of resource constraints.

This summer, Rush's in-vitro fertilization program in Chicago wrote to nearly 300 families, asking them what they wanted done with their potential offspring. The program expects that as many as 30 families will never answer, said director Richard Rawlins. Their abandoned embryos will probably be thawed because "we can't afford to keep them forever," he said.

The soaring number of in-vitro fertilization procedures, now about 100,000 a year, is the source of the dilemma. In these procedures, doctors harvest numerous eggs from a woman's ovaries and fertilize them with sperm. The resulting embryos--microscopic balls of hundreds of cells with no recognizable human characteristics--are carefully grown up to five to six days in petri dishes. At this point, some are implanted in women's wombs while others go into deep storage in liquid nitrogen tanks at minus 320.8 degrees Fahrenheit.

20,000 embryos left behind

Difficulties arise when fertility centers lose touch with patients who move or can't be found despite repeated efforts. As many as 20,000 frozen embryos--about 5 percent of the 400,000 embryos in storage nationwide--have been left behind by couples under these circumstances, according to a study last year by Rand Corp. researchers.

Dina Scolan, 33, of Naperville, who underwent fertility treatment for a year before giving birth to twins 23 months ago, thinks she can guess what some couples feel.

"I would imagine it's escaping responsibility. Not making a decision about what happens [to your embryos] means you don't have to bear the guilt. It leaves the onus on the lab technicians," she said.

Scolan and her husband, Paul, decided to have three frozen embryos thawed earlier this year.

The questions surrounding unwanted embryos are difficult, both ethically and practically. In the absence of direction, who defines what constitutes abandonment and decides what becomes of these embryos? What is the basis for deciding their fate? Who pays the price of continued maintenance and storage?

`Ethically acceptable'

Earlier this year, the American Society for Reproductive Medicine affirmed a policy stating it is "ethically acceptable" for fertility clinics to "consider embryos to have been abandoned if more than five years have passed since contact with a couple, diligent efforts have been made by telephone and registered mail to contact the couple ... and no written instruction from the couple exists concerning disposition."

Under these circumstances, clinics "may dispose of the embryos by removal from storage and thawing," the society concluded.

But with few exceptions, fertility centers aren't following the proposed guidelines. "We'll keep [abandoned embryos] forever," said Dr. Ralph Kazer, chief of the division of infertility at Northwestern Memorial. "I am very, very concerned about legal liability. It's not beyond imagining that a couple could show up after five years in Japan and say, `We're back; we want our embryos,' and what would we do then?"